Medical Credentialing Services

enrolled with great efficiency
Credentialing Service is a demanding step to escape delayed submission of healthcare claims, crossing filing limits, wastage of time, and loss of capital. Credentialing process is managed by our experienced team that helps you navigate the process of provider enrollment and DB credentialing.

Credentialing: Did you know?

Medical credentialing services usually involves gathering information about the physician’s background and qualifications through a formal application that is verified against reliable sources like the National Practitioner Data Bank or the American Board of Medical Specialties.

The Coalition for Affordable Quality Healthcare has offered a uniform DB credentialing program for about 15 years, and this program has been adopted by most payers in the United States.

Typically, when contacted by a hospital, HMO, or employer, physicians are required to answer 800 questions. Information includes items ranging from licensure to practice history in the last five years

The credentialing process takes around 90-120 days and sometimes the process completes quicker if the documents are complete and there are no objections.

To speed up the credentialing process you must proactively gather the required documents, hire a credentialing services provider and ensure accuracy of the information provided.

The good thing about Medicare is that the day they receive the application, providers can bill from that date. Medicare takes 60 – 90 days to complete the credentialing process and sometimes the turnaround time is just 15 days.

The insurance companies take between 60 – 90 days to verify the provider’s educational documents, qualifications, past work experience, and checking the criminal record.

Credentialing is needed to get physicians enrolled with the insurance company. Without credentialing, providers cannot claim insurance companies for reimbursements? Credentialing determines the eligibility of the providers.

Payors usually review provider agreement every 3 years to ensure and most of the organization requires complying with the re-credentialing to ensure provider network quality.

The credentialing process can take up to 3 months to complete. Every organization has a different process to vet the sign-up application and usually, an in-house committee scrutinizes the application form every angle.

The provider credentialing is a process of authenticating the accuracy of provider’s educational documents, career record, malpractice history, licenses, diplomas, certifications, and professional references upon hiring. Providers must be credentialed with the payors and insurance companies to get paid and the process includes NPI and CAQH ProView.